{% extends "myapp/base.html" %}

{% block main_body %}
   <!-- Content Header (Page header) -->
   <section class="content-header">
    <h1>
      病历模板管理
      <small>电子病历系统</small>
    </h1>
    <ol class="breadcrumb">
      <li class="active">病历模板管理</li>
    </ol>
  </section>

  <!-- Main content -->
  <section class="content container-fluid">

    <div class="row">
      <div class="col-xs-12">
        <div class="box">
<!--          <div class="box-header">-->
<!--              <h2 class="box-title"> <span class="glyphicon glyphicon-calendar" aria-hidden="true">编辑模板信息</h2>-->
<!--          </div>-->
          <!-- /.box-header -->
          <!-- form start -->
<!--          <form class="form-horizontal" action="{% url 'myapp_Templateinfo_update' %}" method="post">-->
<!--            <form class="form-horizontal" action="{% url 'myapp_patientinfo_update' %}" method="post">-->
          <form class="form-horizontal" action="{% url 'myapp_Medrecordinfo_insert' %}" method="post">
            {% csrf_token %}
            <div class="box-body">

              <div class="form-group">
                <label class="col-sm-2 control-label">住院号：</label>

                <div class="col-sm-4">
                  <input type="text" name="hspid" readonly value="{{patientinfo.hspid}}" class="form-control"  placeholder="住院号">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">病人姓名：</label>

                <div class="col-sm-4">
                  <input type="text" name="name" value="{{patientinfo.name}}" class="form-control"  placeholder="病人姓名">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">性别：</label>

                <div class="col-sm-4">
                  <input type="text" name="gender" value="{{patientinfo.gender}}" class="form-control"  placeholder="性别" >
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">科室：</label>

                <div class="col-sm-4">
                  <input type="text" name="departname" value="{{patientinfo.departname}}" class="form-control" placeholder="科室"  >
                </div>
              </div>

                <div class="form-group">
                <label  class="col-sm-2 control-label">负责医生：</label>

                <div class="col-sm-4">
                  <input type="text" name="doctorname" value="{{patientinfo.doctorname}}" class="form-control"  placeholder="负责医生">
                </div>
              </div>

              <div class="form-group">
                <label class="col-sm-2 control-label">模板号：</label>

                <div class="col-sm-4">
                  <input type="text" name="templateid" readonly value="{{Templateinfo.templateid}}" class="form-control"  placeholder="模板号">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">主诉：</label>

                <div class="col-sm-4">
                  <input type="text" name="zhusu" value="{{Templateinfo.zhusu}}" class="form-control"  placeholder="主诉">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">现病史：</label>

                <div class="col-sm-4">
                  <input type="text" name="xianbingshi" value="{{Templateinfo.xianbingshi}}" class="form-control"  placeholder="现病史" >
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">既往史：</label>

                <div class="col-sm-4">
                  <input type="text" name="jiwangshi" value="{{Templateinfo.jiwangshi}}" class="form-control" placeholder="既往史"  >
                </div>
              </div>

                <div class="form-group">
                <label  class="col-sm-2 control-label">婚育史：</label>

                <div class="col-sm-4">
                  <input type="text" name="hunyushi" value="{{Templateinfo.hunyushi}}" class="form-control"  placeholder="婚育史">
                </div>
              </div>

                <div class="form-group">
                <label  class="col-sm-2 control-label">月经史：</label>

                <div class="col-sm-4">
                  <input type="text" name="yuejingshi" value="{{Templateinfo.yuejingshi}}" class="form-control"  placeholder="月经史">
                </div>
              </div>

                <div class="form-group">
                <label  class="col-sm-2 control-label">家族史：</label>

                <div class="col-sm-4">
                  <input type="text" name="jiazushi" value="{{Templateinfo.jiazushi}}" class="form-control"  placeholder="家族史">
                </div>
              </div>

               <div class="form-group">
                <label  class="col-sm-2 control-label">体格检查：</label>

                <div class="col-sm-4">
                  <input type="text" name="tigejiancha" value="{{Templateinfo.tigejiancha}}" class="form-control"  placeholder="体格检查">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">专科检查：</label>

                <div class="col-sm-4">
                  <input type="text" name="zhuankejiancha" value="{{Templateinfo.zhuankejiancha}}" class="form-control"  placeholder="专科检查">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">辅助检查：</label>

                <div class="col-sm-4">
                  <input type="text" name="fuzhujiancha" value="{{Templateinfo.fuzhujiancha}}" class="form-control"  placeholder="辅助检查">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">鉴别诊断：</label>

                <div class="col-sm-4">
                  <input type="text" name="jianbiezhenduan" value="{{Templateinfo.jianbiezhenduan}}" class="form-control"  placeholder="鉴别诊断">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">初步诊断：</label>

                <div class="col-sm-4">
                  <input type="text" name="chubuzhenduan" value="{{Templateinfo.chubuzhenduan}}" class="form-control"  placeholder="初步诊断">
                </div>
              </div>

              <div class="form-group">
                <label  class="col-sm-2 control-label">诊疗计划：</label>

                <div class="col-sm-4">
                  <input type="text" name="zhenliaojihua" value="{{Templateinfo.zhenliaojihua}}" class="form-control"  placeholder="诊疗计划">
                </div>
              </div>

              <div class="form-group">
                  <div class="col-sm-offset-2 col-sm-10">
                    <button type="submit"  class="btn btn-primary">保 存</button>
                  </div>
              </div>
            </div>
            <!-- /.box-footer -->
          </form>
        </div>
        <!-- /.box -->
      </div>
    </div>

  </section>
  <!-- /.content -->
{% endblock %}